Surgical instruments and methods for performing tonsillectomy and adenoidectomy procedures

ABSTRACT

A method of surgery includes grasping tissue between tissue-treating plates of first and second jaw members by moving the first and second jaw members from a spaced-apart position to a first approximated position, energizing the tissue-treating plates to conduct energy through the grasped tissue to treat tissue, and separating grasped and treated tissue by moving the first and second jaw members from the first approximated position to a second approximated position. Moving the first and second jaw members from the first approximated position to the second approximated position laterally shifts the jaw members relative to one another from an aligned orientation, wherein the tissue-treating plates are aligned with one another, to an offset orientation, wherein the tissue-treating plates are offset relative to one another.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of, and priority to, U.S.Provisional Patent Application Nos. 62/035,751 and 62/035,764, both ofwhich were filed on Aug. 11, 2014. This application is related to U.S.patent application Ser. No. 14/738,107, filed on Jun. 12, 2015. Theentire contents of each of the above applications are herebyincorporated herein by reference.

BACKGROUND

Technical Field

The present disclosure relates to surgical instruments and methods and,more particularly, to surgical instruments and methods for performingtonsillectomy and/or adenoidectomy procedures.

Background of Related Art

The tonsils and adenoids are part of the lymphatic system and aregenerally located in the back of the throat. These parts of thelymphatic system are generally used for sampling bacteria and virusesentering the body and activating the immune system when warranted toproduce antibodies to fight oncoming infections. More particularly, thetonsils and adenoids break down the bacteria or virus and send pieces ofthe bacteria or virus to the immune system to produce antibodies forfighting off infections.

Inflammation of the tonsils and adenoids (e.g., tonsillitis) impedes theability of the tonsils and adenoids to destroy the bacteria resulting ina bacterial infection. In many instances, the bacteria remain even aftertreatment and serve as a reservoir for repeated infections (e.g.,tonsillitis or ear infections).

A tonsillectomy and/or adenoidectomy may be performed when infectionspersist and antibiotic treatments fail. Persistent infection typicallyleads to enlarged tonsil tissue which may need to be removed since inmany cases the enlarged tissue causes airway obstruction leading tovarious sleep disorders such as snoring or, in some cases, sleep apnea.Some individuals are also born with larger tonsils that are more proneto cause obstruction. An adenoidectomy may also be required to removeadenoid tissue when ear pain persists, or when nose breathing orfunction of the Eustachian tube is impaired. Often times, tonsillectomyand adenoidectomy procedures are performed at the same time.

SUMMARY

As used herein, the term “distal” refers to the portion that is beingdescribed which is further from a user, while the term “proximal” refersto the portion that is being described which is closer to a user.Further, to the extent consistent, any of the aspects described hereinmay be used in conjunction with any or all of the other aspectsdescribed herein.

A method of surgery provided in accordance with aspects of the presentdisclosure utilizes an end effector assembly including first and secondjaw members. At least one of the jaw members includes a bifurcated bodyhaving first and second jaw components. Each of the jaw componentsincludes a tissue-treating plate portion disposed thereon. Thetissue-treating plate portions cooperate to define the tissue-treatingplate of the jaw member. The method includes grasping tissue between thetissue-treating plates of the first and second jaw members, energizingthe tissue-treating plates of the first and second jaw members forconducting energy through grasped tissue to treat grasped tissue, andseparating grasped and treated tissue by rotating at least one of thefirst and second jaw components of the at least one jaw member relativeto the other from an aligned orientation, wherein the tissue-treatingplate portions are substantially co-planar relative to one another, toan angled orientation, wherein the tissue-treating plate portions areangled relative to one another.

In an aspect of the present disclosure, grasping tissue includescompressing a movable handle relative to a fixed handle to pivot thefirst and second jaw members from a spaced-apart position to anapproximated position.

In another aspect of the present disclosure, separating grasped andtreated tissue includes actuating a trigger to translate an actuationmember from a first position to a second position to rotate the at leastone of the first and second jaw components from the aligned orientationto the angled orientation.

Another method of surgery provided in accordance with aspects of thepresent disclosure includes utilizing and end effector assemblyincluding first and second jaw members each including first and secondspaced-apart tissue-treating plate portions. At least one of the jawmembers includes a bifurcated body having a first jaw componentincluding the first tissue-treating plate portion thereof and a secondjaw component including the second tissue-treating plate portionthereof. The method includes grasping tissue between the firsttissue-treating plate portions of the jaw members and between the secondtissue-treating plate portions of the jaw members by moving the firstand second jaw members from a spaced-apart position to a firstapproximated position, energizing the tissue-treating plate portions ofthe first and second jaw members for conducting energy through graspedtissue to treat grasped tissue, and separating grasped and treatedtissue by moving the first and second jaw components of the at least onejaw member laterally apart from one another.

In an aspect of the present disclosure, separating grasped and treatedtissue includes moving the first and second jaw members from the firstapproximated position to a second approximated position. In suchaspects, moving the first and second jaw members from the firstapproximated position to the second approximated position urges thefirst and second jaw components of the at least one jaw member laterallyapart from one another.

In another aspect of the present disclosure, grasping tissue includescompressing a movable handle relative to a fixed handle from an initialposition to a first compressed position to move the jaw members from thespaced-apart position to the first approximated position and separatinggrasped and treated tissue includes compressing the movable handle fromthe first compressed position to a second compressed position to movethe jaw members from the first approximated position to the secondapproximated position.

In yet another aspect of the present disclosure, the first jaw memberincludes an insulative member disposed between the tissue-treating plateportions thereof and the second jaw member includes the bifurcated bodyhaving the first jaw component and the second jaw component. In suchaspects, moving the first and second jaw members from the firstapproximated position to the second approximated position urges theinsulative member at least partially between the first and second jawcomponents to urge the first and second jaw components laterally apartfrom one another.

In still another aspect of the present disclosure, each of the jawmembers includes a bifurcated body having a first jaw componentincluding the first tissue-treating plate portion thereof and a secondjaw component including the second tissue-treating plate portionthereof. In such aspects, separating grasped and treated tissue includesmoving the first jaw components of the first and second jaw members andthe second jaw components of the first and second jaw componentslaterally apart from one another.

Another method of surgery provided in accordance with the presentdisclosure includes grasping tissue between tissue-treating plates offirst and second jaw members by moving the first and second jaw membersfrom a spaced-apart position to a first approximated position,energizing the tissue-treating plates of the first and second jawmembers for conducting energy through grasped tissue to treat graspedtissue, and separating grasped and treated tissue by moving the firstand second jaw members from the first approximated position to a secondapproximated position. Moving the first and second jaw members from thefirst approximated position to the second approximated positionlaterally shifts the jaw members relative to one another from an alignedorientation, wherein the tissue-treating plates are aligned with oneanother, to an offset orientation, wherein the tissue-treating platesare offset relative to one another.

In aspects, grasping tissue includes compressing a movable handlerelative to a fixed handle from an initial position to a firstcompressed position to move the jaw members from the spaced-apartposition to the first approximated position and separating grasped andtreated tissue includes compressing the movable handle from the firstcompressed position to a second compressed position to move the jawmembers from the first approximated position to the second approximatedposition.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and features of the present disclosure are describedherein with reference to the drawings wherein:

FIG. 1 is a front, side, perspective view of an endoscopic surgicalforceps configured for use in accordance with the present disclosure;

FIG. 2 is a front, side, perspective view of an open surgical forcepsconfigured for use in accordance with the present disclosure;

FIG. 3A is a side, cut-away view of the proximal portion of the surgicalforceps of FIG. 1, wherein a portion of the housing and some of theinternal components thereof have been removed to unobstructivelyillustrate the handle, actuation, and drive assemblies of the forceps;

FIG. 3B is a perspective, cut-away view of the distal portion of thesurgical forceps of FIG. 1, wherein the shaft has been removed toillustrate the drive bar, actuation assembly, and end effector assemblyof the forceps;

FIG. 4A is a top view of one of the jaw members of the end effectorassembly of FIG. 3B and the actuation assembly of FIG. 3A-3B, disposedin an un-actuated condition;

FIG. 4B is a transverse, cross-sectional view of the end effectorassembly of FIG. 3B and the actuation assembly of FIG. 3A-3B, disposedin the un-actuated condition;

FIG. 5A is a top view of jaw member of FIG. 3B and the actuationassembly of FIG. 3A-3B, disposed in an actuated condition;

FIG. 5B is a transverse, cross-sectional view of the end effectorassembly of FIG. 3B and the actuation assembly of FIG. 3A-3B, disposedin the actuated condition;

FIG. 6A is a top view of one of the jaw members of another end effectorassembly provided in accordance with the present disclosure, disposed inan un-actuated condition;

FIG. 6B is a transverse, cross-sectional view of the end effectorassembly of FIG. 6A, disposed in the un-actuated condition;

FIG. 7A is a top view of the jaw member of FIG. 6A, disposed in anactuated condition;

FIG. 7B is a transverse, cross-sectional view of the end effectorassembly of FIG. 7A, disposed in the actuated condition;

FIG. 8A is a transverse, cross-sectional view of proximal flanges of thejaw members of another end effector assembly provided in accordance withthe present disclosure, disposed in an un-actuated condition;

FIG. 8B is a transverse, cross-sectional view of the jaw bodies of thejaw members of the end effector assembly of FIG. 8A, disposed in theun-actuated condition;

FIG. 9A is a is a transverse, cross-sectional view of the proximalflanges of the jaw members of the end effector assembly of FIG. 8A,disposed in an actuated condition;

FIG. 9B is a transverse, cross-sectional view of the jaw bodies of thejaw members of the end effector assembly of FIG. 8A, disposed in theactuated condition;

FIG. 10A is a transverse, cross-sectional view of the jaw bodies ofanother end effector assembly provided in accordance with the presentdisclosure, disposed in an un-actuated condition; and

FIG. 10B is a transverse, cross-sectional view of the jaw bodies of thejaw members of the end effector assembly of FIG. 10A, disposed in anactuated condition.

DETAILED DESCRIPTION

Turning to FIGS. 1 and 2, FIG. 1 depicts a handheld, shaft-basedsurgical forceps 10 and FIG. 2 depicts a hemostat-style forceps 10′. Forthe purposes herein, either forceps 10, forceps 10′, or any othersuitable surgical instrument may be utilized in accordance with thepresent disclosure. Obviously, different electrical and mechanicalconnections and considerations apply to each particular type ofinstrument; however, the aspects and features of the present disclosureremain generally consistent regardless of the particular instrumentused.

Referring to FIG. 1, forceps 10 generally includes a housing 20, ahandle assembly 30, an actuation assembly 60, a rotating assembly 70, anactivation switch 4, and an end effector assembly 100. Forceps 10further includes a shaft 12 having a distal end 14 configured tomechanically engage end effector assembly 100 and a proximal end 16 thatmechanically engages housing 20. Forceps 10 also includes cable 2 thatconnects forceps 10 to an energy source (not shown), e.g., a generatoror other suitable power source, although forceps 10 may alternatively beconfigured as a battery-powered device. Cable 2 includes a wire (orwires) (not shown) extending therethrough that has sufficient length toextend through shaft 12 in order to provide energy to one or bothtissue-treating plates 114, 124 (FIG. 3B) of jaw members 110, 120,respectively. Activation switch 4 is coupled to tissue-treating plates114, 124 (FIG. 3B) of jaw members 110, 120, respectively, and the sourceof energy for selectively activating the supply of energy to jaw members110, 120 for treating, e.g., cauterizing, coagulating/desiccating,and/or sealing, tissue.

With additional reference to FIGS. 3A and 3B, handle assembly 30includes fixed handle 50 and a movable handle 40. Fixed handle 50 isintegrally associated with housing 20 and handle 40 is movable relativeto fixed handle 50. Movable handle 40 of handle assembly 30 is operablycoupled to a drive assembly 140 that, together, mechanically cooperateto impart movement of one or both of jaw members 110, 120 about a pivot103 between a spaced-apart position and an approximated position tograsp tissue between jaw members 110, 120. In particular, movable handle40 is coupled to drive bar 142 via a drive mandrel 144 such thatmovement of movable handle 40 relative to housing 20 effectslongitudinal translation of drive bar 142 through housing 20 and shaft12. The distal end of drive bar 142 is coupled to one or both jawmembers 110, 120 such that longitudinal translation of drive bar 142relative to end effector assembly 100 pivots one or both of jaw members110, 120 relative to one another. As shown in FIG. 1, movable handle 40is initially spaced-apart from fixed handle 50 and, correspondingly, jawmembers 110, 120 are disposed in the spaced-apart position. Movablehandle 40 is depressible from this initial position to a depressedposition corresponding to the approximated position of jaw members 110,120. Further, a biasing member 146 may be disposed within housing 20 andpositioned to bias drive bar 142 distally, thereby biasing jaw members110, 120 towards the spaced-apart position. However, otherconfigurations are also contemplated.

Actuation assembly 60 includes a trigger 62 coupled to housing 20 andmovable relative thereto between an un-actuated position and an actuatedposition. More specifically, trigger 62 is operably coupled to anactuation bar 161 (e.g., similarly as with the coupling of movablehandle 40 to drive bar 142) such that movement of trigger 62 relative tohousing 20 effects longitudinal translation of actuation bar 161 throughhousing 20 and shaft 12. The distal end of actuation bar 161 is coupledto one or both jaw members 110, 120 such that longitudinal translationof actuation bar 161 effects transitioning of end effector assembly 100between the un-actuated condition (FIGS. 4A and 4B) and the actuatedcondition (FIGS. 5A and 5B). Trigger 62, as shown in FIG. 1, isinitially disposed in the un-actuated position and, correspondingly, endeffector assembly 100 is disposed in the un-actuated condition (FIGS. 4Aand 4B). Trigger 62 is selectively actuatable from this un-actuatedposition to an actuated position corresponding to the actuated conditionof end effector assembly 100 (FIGS. 5A and 5B). Further, a biasingmember 166 may be disposed within housing 20 and positioned to biasactuation bar 161 proximally, thereby biasing end effector assembly 100towards the un-actuated condition and trigger 62 towards the un-actuatedposition. The operable distal components of actuation assembly 60 andthe functions thereof are described in greater detail below.

Referring to FIG. 2, forceps 10′ is shown including two elongated shaftmembers 12 a, 12 b, each having a proximal end 16 a, 16 b, and a distalend 14 a, 14 b, respectively. Forceps 10′ is configured for use with anend effector assembly 100′ similar to end effector assembly 100 (FIGS. 1and 3B). More specifically, end effector assembly 100′ includes firstand second jaw members 110′, 120′ attached to respective distal ends 14a, 14 b of shaft members 12 a, 12 b. Jaw members 110′, 120′ arepivotably connected about a pivot 103′. Each shaft member 12 a, 12 bincludes a handle 17 a, 17 b disposed at the proximal end 16 a, 16 bthereof. Each handle 17 a, 17 b defines a finger hole 18 a, 18 btherethrough for receiving a finger of the user. As can be appreciated,finger holes 18 a, 18 b facilitate movement of the shaft members 12 a,12 b relative to one another to, in turn, pivot jaw members 110′, 120′from the spaced-apart position, wherein jaw members 110′, 120′ aredisposed in spaced relation relative to one another, to the approximatedposition, wherein jaw members 110′, 120′ cooperate to grasp tissuetherebetween.

One of the shaft members 12 a, 12 b of forceps 10′, e.g., shaft member12 a, includes a proximal shaft connector 19 configured to connect theforceps 10′ to a source of energy (not shown), e.g., a generator.Proximal shaft connector 19 secures a cable 2′ to forceps 10′ such thatthe user may selectively supply energy to jaw members 110′, 120′ fortreating tissue and for energy-based tissue cutting. More specifically,an activation switch 4′ is provided for supplying energy to jaw members110′, 120′ to treat tissue upon sufficient approximation of shaftmembers 12 a, 12 b, e.g., upon activation of activation switch 4′ viashaft member 12 b.

Forceps 10′ further includes an actuation assembly 60′ including atrigger 62′ coupled to one of the shaft members, e.g., shaft member 12b, and movable relative thereto between an un-actuated position and anactuated position for transitioning end effector assembly 100′ betweenan un-actuated condition and an actuated condition, similarly as withend effector assembly 100 (FIG. 3B).

With reference to FIG. 3B, end effector assembly 100 of forceps 10(FIG. 1) is shown, although end effector assembly 100 may similarly beused in conjunction with forceps 10′ (FIG. 2), or any other suitablesurgical instrument. For purposes of simplicity, end effector assembly100 is described herein as configured for use with forceps 10 (FIG. 1).Further, end effector assembly 100 is initially generally describedbelow with reference to FIG. 3B, followed by a more detailed descriptionof the particular features and function thereof with reference to FIGS.4A-5B. End effector assembly 100, and the various other configurationsof end effector assemblies detailed below with respect to FIGS. 6A-10B,are suitable for use in performing tonsillectomy and/or adenoidectomyprocedures, although such end effector assemblies may equally beapplicable for use in other surgical procedures. Each of the variousconfigurations detailed below with respect to FIGS. 6A-10B mayincorporate the general features of end effector assembly 100 and maylikewise be used with forceps 10 (FIG. 1), forceps 10′ (FIG. 2), or anyother suitable surgical instrument. That is, the general featuresdetailed with respect to end effector assembly 100 (FIG. 3B), are alsoapplicable to the end effector assemblies of FIGS. 6A-10B, except wherespecifically contradicted.

Each jaw member 110, 120 of end effector assembly 100 includes a jawframe having a proximal flange portion 111, 121, an outer insulative jawhousing 112, 122 disposed about the distal portion (not explicitlyshown) of each jaw frame, and a tissue-treating plate 114, 124,respectively. Proximal flange portions 111, 121 are pivotably coupled toone another about pivot 103 for moving jaw members 110, 120 between thespaced-apart and approximated positions, although other suitablemechanisms for pivoting jaw members 110, 120 relative to one another arealso contemplated. The distal portions (not explicitly shown) of the jawframes are configured to support jaw housings 112, 122, andtissue-treating plates 114, 124, respectively, thereon.

Outer insulative jaw housings 112, 122 of jaw members 110, 120 supportand retain tissue-treating plates 114, 124 on respective jaw members110, 120 in opposed relation relative to one another. Tissue-treatingplates 114, 124 are formed from an electrically conductive material,e.g., for conducting electrical energy therebetween for treating tissue,although tissue-treating plates 114, 124 may alternatively be configuredto conduct any suitable energy, e.g., thermal, microwave, light,ultrasonic, etc., through tissue grasped therebetween for energy-basedtissue treatment. As mentioned above, tissue-treating plates 114, 124are coupled to activation switch 4 (FIG. 1) and the source of energy(not shown), e.g., via the wires (not shown) extending from cable 2(FIG. 1) through forceps 10 (FIG. 1), such that energy may beselectively supplied to tissue-treating plate 114 and/or tissue-treatingplate 124 and conducted therebetween and through tissue disposed betweenjaw members 110, 120 to treat tissue. Tissue-treating plates 114, 124may define serrated configurations to facilitate grasping and cutting oftissue, as detailed below.

With additional reference to FIGS. 4A-5B, one of the jaw members of endeffector assembly 100, e.g., jaw member 120, defines a bifurcatedconfiguration including first and second jaw components 120 a, 120 b.First and second jaw components 120 a, 120 b of jaw member 120 extendlongitudinally in side-by-side relation relative to one another and eachincludes a tissue-treating plate portion 124 a, 124 b that together formtissue-treating plate 124. Although shown as substantially equal, it isenvisioned that jaw components 120 a, 120 b may define any suitableequal or unequal widths.

One of the jaw components of jaw member 120, e.g., jaw component 120 a,is rotatably coupled to proximal flange portion 121 of jaw member 120via a rod 126, although it is also contemplated that both jaw components120 a, 120 b be rotatable relative to proximal flange portion 121. Rod126 extends longitudinally such that jaw component 120 a is rotatablebetween an aligned orientation, corresponding to the un-actuatedcondition of end effector assembly 100, wherein tissue-treating plateportion 124 a and tissue-treating plate portion 124 b are substantiallycoplanar relative to one another (FIGS. 4A and 4B), and an angledorientation, corresponding to the actuated condition of end effectorassembly 100, wherein tissue-treating plate portion 124 a is angled withrespect to tissue-treating plate portion 124 b (FIGS. 5A and 5B).Further, one of the jaw components, e.g., jaw component 120 b, maydefine a cut-out 125 to permit rotation of jaw component 120 a relativethereto.

Actuator drive bar 161 of actuator assembly 60 (FIG. 3A) includes anactuator member 168 disposed at the distal end thereof that isconfigured for insertion between jaw components 120 a, 120 b to rotatejaw component 120 b relative to jaw component 120 a, thereby rotatingtissue-treating plate portion 124 a relative to tissue-treating plateportion 124 b from the aligned orientation to the angled orientation.More specifically, actuator member 168 defines a wedge-likeconfiguration and is configured for insertion between jaw components 120a, 120 b at a position offset, e.g., above or below, relative to rod126. As such, insertion of the wedge-like actuator member 168 jawcomponents 120 a, 120 b urges jaw component 120 a and tissue-treatingplate portion 124 a thereof to rotate towards the angled orientation.Trigger 62 of actuator assembly 60 (FIG. 3A), as noted above, isselectively actuatable to advance actuator drive bar 161 and, thus,actuator member 168 between jaw components 120 a, 120 b to transitionend effector assembly 100 to the actuated condition. One or more biasingmembers 129 may be disposed between jaw components 120 a, 120 b at aposition offset relative to rod 126, on an opposite side of rod 126 ascompared to actuator member 168 to bias jaw components 120 a, 120 btowards the aligned orientation, corresponding to the un-actuatedcondition of end effector assembly 100.

In use, with end effector assembly 100 disposed in the un-actuatedcondition (FIGS. 4A and 4B) and jaw members 110, 120 disposed in thespaced-apart position, end effector assembly 100 is manipulated intoposition such that tissue to be treated and cut is disposed between jawmembers 110, 120. With respect to tonsillectomy procedures, for example,end effector assembly 100 is positioned between the cavity wall tissue(or other tissue to remain) and the tonsil tissue (or other tissue to beremoved). Once the desired position has been achieved, jaw members 110,120 are moved to the approximated position, e.g., via moving movablehandle 40 (FIG. 3A) to the depressed condition, to grasp tissue betweentissue-treating plate 114 and tissue-treating plates 124 a, 124 b.Thereafter, tissue-treating plate 114 may be energized to a firstelectrical potential and tissue-treating plate portions 124 a, 124 b toa second, different electrical potential for conducting energy betweenplate 114 and plate portions 124 a, 124 b and through tissue graspedtherebetween to treat tissue.

Once tissue has been treated the tissue to be removed, e.g., the tonsiltissue, is separated from the tissue to remain, e.g., the wall tissue.In order to separate the tissue, while maintaining jaw members 110, 120in the approximated position grasping the previously treated tissuebetween the serrated tissue-treating plate 114 and plate portions 124 a,124 b, trigger 62 (FIG. 3A) is moved from the un-actuated position tothe actuated position. Actuation of trigger 62 (FIG. 3A) advancesactuation drive rod 161 and actuation member 168 distally such thatactuation member 168 is inserted between jaw components 120 a, 120 b tourge jaw component 120 a to rotate relative to jaw component 120 b fromthe aligned orientation, e.g., the un-actuated condition of end effectorassembly 100, to the angled orientation, e.g., the actuated condition ofend effector assembly 100. As tissue-treating plate portion 124 a isrotated relative to tissue-treating plate portion 124 b andtissue-treating plate 114, the previously treated tissue grasped betweenjaw members 110, 120, which is substantially held in position via theserrated tissue-treating plate 114 and plate portions 124 a, 124 b, iscut in a dynamic shearing and/or ripping fashion, ultimately separatingthe tonsil tissue to be removed from the wall tissue to remain. Theseparated tonsil tissue may then be removed using end effector assembly100, another grasping instrument, a suction device, or via othersuitable method.

Turning to FIGS. 6A-7B, another embodiment of an end effector assemblyis shown generally identified by reference numeral 200. End effectorassembly 200 may be configured for use with forceps 10 (FIG. 1), forceps10′ (FIG. 2), or any other suitable surgical instrument, except thatactuation assembly 60, 60′ (FIGS. 1 and 2, respectively), need not beprovided. Rather, as detailed below, end effector assembly 200 isconfigured for treating and cutting tissue by moving jaw members 210,220 from a spaced-apart position to a first approximated position tograsp and treat tissue, and further to a second approximated position tocut tissue. With additional reference to FIG. 1 momentarily, this may beaccomplished, for example, via moving movable handle 40 of forceps 10from the initial position to a first compressed position correspondingto the first approximated position of jaw members 210, 220, and to thenfurther to a second approximated position of jaw members 210, 220.

Each jaw member 210, 220 of end effector assembly 200 includes a jawframe having a proximal flange portion 221 (although not shown, theproximal flange portion of jaw member 210 is similar proximal flangeportion 221 of jaw member 220), an outer insulative jaw housing 212, 222disposed about the distal portion (not explicitly shown) of each jawframe, and a tissue-treating plate 214, 224, respectively. The proximalflange portion (not shown) of jaw member 210 and proximal flange portion221 of jaw member 220 are pivotably coupled to one another for movingjaw members 210, 220 between the spaced-apart position, firstapproximated position (FIG. 6B), and second approximated position (FIG.7B). The distal portions of the jaw frames are configured to support jawhousings 212, 222, and tissue-treating plates 214, 224, respectively,thereon. Tissue-treating plates 214, 224 are formed from an electricallyconductive material, e.g., for conducting electrical energy therebetweenfor treating tissue, similarly as detailed above. Further,tissue-treating plates 214, 224 may define serrated configurations tofacilitate grasping and cutting of tissue, as detailed below.

One of the jaw members of end effector assembly 200, e.g., jaw member220, defines a bifurcated configuration including first and second jawcomponents 220 a, 220 b. First and second jaw components 220 a, 220 b ofjaw member 220 extend longitudinally in side-by-side relation relativeto one another and each includes a tissue-treating plate portion 224 a,224 b of tissue-treating plate 224. One or more biasing members 229 maybe disposed between jaw components 220 a, 220 b to bias jaw components220 a, 220 b towards one another, corresponding to the un-actuatedcondition of end effector assembly 200. As detailed below, when jawmembers 210, 220 are moved to the second approximated position, jawmember 210 urges jaw components 220 a, 220 b apart from one anotheragainst the bias of biasing members 229, corresponding to the actuatedcondition of end effector assembly 200.

The other jaw member of end effector assembly 200, e.g., jaw member 210includes a pair of spaced-apart, substantially planar tissue-contactingplate portions 214 a, 214 b that together define plate 214. Positionedbetween the spaced-apart plate portions 214 a, 214 b of jaw member 210is an insulative member 218. More specifically, insulative member 218extends longitudinally between plate portions 214 a, 214 b and towardsjaw member 220. Insulative member 218 defines generally trapezoidaltransverse cross-sectional configuration having angled sides 219 a, 219b, although other configurations are also contemplated. Angled sides 219a, 219 b permit the free end of insulative member 218 to extendpartially between jaw components 220 a, 220 b of jaw member 220 in thefirst approximated position of end effector assembly 200 withouteffecting relative movement of jaw components 220 a, 220 b (theun-actuated condition of end effector assembly 200). However, uponfurther approximation of jaw members 210, 220, e.g., to the secondapproximated position, insulative member 218 extends further between jawcomponents 220 a, 220 b such that angled sides 219 a, 219 b urge jawcomponents 220 a, 220 b apart from one another against the bias ofbiasing member 229 (the actuated condition of end effector assembly200).

In use, with end effector assembly 200 disposed in the un-actuatedcondition (FIGS. 6A and 6B) and jaw members 210, 220 disposed in thespaced-apart position, end effector assembly 200 is manipulated intoposition such that tissue to be treated and cut is disposed between jawmembers 210, 220. With respect to tonsillectomy procedures, for example,end effector assembly 200 is positioned between the cavity wall tissue(or other tissue to remain) and the tonsil tissue (or other tissue to beremoved). Once the desired position has been achieved, jaw members 210,220 are moved to the first approximated position to grasp tissue betweentissue-treating plates 214, 224 and, more specifically, betweentissue-treating plate portions 214 a, 214 b and tissue-treating plateportions 224 a, 224 b, respectively. In the first approximated position,jaw components 220 a, 220 b of jaw member 220 are disposed in closeproximity to one another such that plate portions 214 a, 214 b and plateportions 224 a, 224 b, respectively, are aligned with one another.Thereafter, tissue-treating plate portions 214 a, 214 b may be energizedto a first electrical potential and tissue-treating plate portions 224a, 224 b to a second, different electrical potential for conductingenergy therebetween and through tissue grasped between jaw members 210,220 to treat tissue.

Once tissue has been treated, the tissue to be removed, e.g., the tonsiltissue, is separated from the tissue to remain, e.g., the wall tissue.In order to separate the tissue, jaw members 210, 220 are moved from thefirst approximated position to the second approximated position suchthat insulative member 218 is advanced between jaw components 220 a, 220b of jaw member 220 and urges jaw components 220 a, 220 b apart from oneanother to the actuated condition of end effector assembly 200. Movementof jaw components 220 a, 220 b to the actuated condition movestissue-treating plate portions 224 a, 224 b apart from one another andrelative to tissue-treating plate portions 214 a, 214 b such that thepreviously treated tissue grasped between jaw members 210, 220, which issubstantially held in position via the serrated tissue-treating plateportions 214 a, 214 b and 224 a, 224 b, respectively, is cut in adynamic shearing and/or ripping fashion, ultimately separating thetonsil tissue to be removed from the wall tissue to remain. Theseparated tonsil tissue may then be removed using end effector assembly200, another grasping instrument, a suction device, or via othersuitable method.

Turning to FIGS. 8A-9B, another embodiment of an end effector assemblyis shown generally identified by reference numeral 300. End effectorassembly 300 may be configured for use with forceps 10 (FIG. 1), forceps10′ (FIG. 2), or any other suitable surgical instrument, except thatactuation assembly 60, 60′ (FIGS. 1 and 2, respectively), need not beprovided. Rather, similarly as with end effector assembly 200 (FIGS.6A-7B), and as detailed below, end effector assembly 300 is configuredfor treating and cutting tissue by moving jaw members 310, 320 from aspaced-apart position to a first approximated position to grasp andtreat tissue, and further to a second approximated position to cuttissue.

Each jaw member 310, 320 of end effector assembly 300 includes a jawframe having a proximal flange portion 311, 321, an outer insulative jawhousing 312, 322 disposed about the distal portion (not explicitlyshown) of each jaw frame, and a tissue-treating plate 314, 324,respectively. Proximal flange portions 311, 321 are pivotably coupled toone another about a pivot 303 for moving jaw members 310, 320 betweenthe spaced-apart position, first approximated position (FIG. 8B), andsecond approximated position (FIG. 9B). The distal portions of the jawframes are configured to support jaw housings 312, 322, andtissue-treating plates 314, 324, respectively, thereon. Tissue-treatingplates 314, 324 are formed from an electrically conductive material,e.g., for conducting electrical energy therebetween for treating tissue,similarly as detailed above. Further, tissue-treating plates 314, 324may define serrated configurations to facilitate grasping and cutting oftissue, as detailed below.

As mentioned above, proximal flange portions 311, 321 are pivotablycoupled to one another about pivot 303. More specifically, proximalflange portions 311, 321 are disposed about pivot 303 with at least someplay therebetween to permit one or both of proximal flange portions 311,321 to move towards and away from the other along pivot 303. A biasingmember 305 may be disposed about pivot 303 and coupled between proximalflange portions 311, 321 to bias proximal flange portions 311, 321towards one another, thereby biasing jaw members 310, 320 towards analigned configuration, corresponding to the un-actuated condition of endeffector assembly 300. Biasing member 305 further serves to inhibit jawsplay during movement of jaw members 310, 320 between the spaced-apartposition and the first approximated position.

Proximal flange portions 311, 321 of jaw members 310, 320 each furtherinclude an inwardly-extending protrusion 317, 327 defining a rampedsurface 318, 328, respectively. Ramped surfaces 318, 328 are positionedto oppose one another and to slidably contact one another upon movementof jaw members 310, 320 from the first approximated position (FIG. 8A)to the second approximated position (FIG. 9A). More specifically, in thefirst approximated position, ramped surfaces 318, 328 are spaced-apartfrom one another (see FIG. 8A) and, as such, jaw members 310, 320 arebiased to the aligned configuration, corresponding to the un-actuatedcondition of end effector assembly 300 (see FIG. 8B). Upon movement ofjaw members 310, 320 to the second approximated position, rampedsurfaces 318, 328 slidably contact one another and, due to the rampedconfigurations of protrusions 317, 327, increasingly urge proximalflange portions 311, 321 apart from one another (see FIG. 9A) to therebymove jaw members 310, 320 towards an offset configuration, correspondingto the actuated condition of end effector assembly 300 (see FIG. 9B).

In use, with end effector assembly 300 disposed in the un-actuatedcondition (FIGS. 8A and 8B) and jaw members 310, 320 disposed in thespaced-apart position, end effector assembly 300 is manipulated intoposition such that tissue to be treated and cut is disposed between jawmembers 310, 320. With respect to tonsillectomy procedures, for example,end effector assembly 300 is positioned between the cavity wall tissue(or other tissue to remain) and the tonsil tissue (or other tissue to beremoved). Once the desired position has been achieved, jaw members 310,320 are moved to the first approximated position to grasp tissue betweentissue-treating plates 314, 324. Thereafter, tissue-treating plate 314may be energized to a first electrical potential and tissue-treatingplate 324 to a second, different electrical potential for conductingenergy therebetween and through tissue grasped between jaw members 310,320 to treat, e.g., seal, tissue.

Once tissue has been treated, the tissue to be removed, e.g., the tonsiltissue, is separated from the tissue to remain, e.g., the wall tissue.In order to separate the tissue, jaw members 310, 320 are moved from thefirst approximated position to the second approximated position suchthat ramped surfaces 318, 328 slidably contact one another and urgeproximal flange portions 311, 321 apart from one another to move jawmembers 310, 320 to the actuated condition of end effector assembly 300.Movement of jaw members 310, 320 to the actuated condition movestissue-treating plates 314, 324 relative to one another such that thepreviously treated tissue grasped between jaw members 310, 320, which issubstantially held in position via the serrated tissue-treating plates314, 324 is cut in a dynamic shearing and/or ripping fashion, ultimatelyseparating the tonsil tissue to be removed from the wall tissue toremain. The separated tonsil tissue may then be removed using endeffector assembly 300, another grasping instrument, a suction device, orvia other suitable method.

Turning to FIGS. 10A and 10B, another embodiment of an end effectorassembly is shown generally identified by reference numeral 400. Endeffector assembly 400 may be configured for use with forceps 10 (FIG.1), forceps 10′ (FIG. 2), or any other suitable surgical instrument. Endeffector assembly 400 is configured for treating and cutting tissue bymoving jaw members 410, 420 from a spaced-apart position to anapproximated position (FIG. 10A) to grasp and treat tissue, and then bymoving each jaw member 410, 420 from an un-actuated position to anactuated position (FIG. 10B) to cut tissue. Movement between thespaced-apart and approximated positions may be accomplished via movingmovable handle 40 of forceps 10 (FIG. 1) from the initial position to afirst compressed position, while moving movable handle 40 (FIG. 1) fromthe first compressed position to a second compressed position may beeffected to both move jaw members 410, 420 to a further approximatedposition and move of each of jaw members 410, 420 from the un-actuatedposition to the actuated position, similarly as with end effectorassemblies 200 or 300 (FIGS. 6A-7B and FIGS. 8A-9B, respectively).Alternatively, with jaw members 410, 420 disposed in the approximatedposition, each jaw member 410, 420 may be moved from the un-actuatedposition to the actuated position via actuation of trigger 62 (FIG. 3A),similarly as with end effector assembly 100 (FIGS. 4A-5B).

Each jaw member 410, 420 of end effector assembly 400 defines abifurcated configuration including first and second jaw components 410a, 410 b and 420 a, 420 b, respectively. First and second jaw components410 a, 410 b and 420 a, 420 b of respective jaw members 410, 420 extendlongitudinally in side-by-side relation relative to one another and eachincludes a tissue-treating plate portion 414 a, 414 b and 424 a, 424 bthat cooperate to define the tissue-treating plates of jaw members 410,420. Tissue-treating plate portions 414 a, 414 b and 424 a, 424 b areformed from an electrically conductive material, e.g., for conductingelectrical energy therebetween for treating tissue, similarly asdetailed above. Further, tissue-treating plate portions 414 a, 414 b and424 a, 424 b may define serrated configurations to facilitate graspingand cutting of tissue, as detailed below.

As noted above, jaw members 410, 420 of end effector assembly 400 areconfigured to move between a spaced-apart position and an approximatedposition (FIG. 10A), and each jaw member 410, 420, with the jaw members410, 420 disposed in the approximated position (FIG. 10A), is furtherconfigured to move between an un-actuated position (FIG. 10A) and anactuated position (FIG. 10B). As also noted above, in some embodiments,the actuated position of each of jaw members 410, 420 corresponds to afurther approximated position of jaw members 410, 420. In eitherconfiguration, in the un-actuated position, jaw components 410 a, 410 bof jaw member 410 are positioned adjacent one another in close proximityto one another and, similarly, jaw components 420 a, 420 b of jaw member420 are positioned adjacent one another in close proximity to oneanother. Upon movement of jaw members 410, 420 to the actuated position,jaw components 410 a, 410 b of jaw member 410 are moved apart from oneanother and, similarly, jaw components 420 a, 420 b of jaw member 420are moved apart from one another.

In use, with jaw members 410, 420 initially disposed in the spaced-apartposition, end effector assembly 400 is manipulated into position suchthat tissue to be treated and cut is disposed between jaw members 410,420. With respect to tonsillectomy procedures, for example, end effectorassembly 400 is positioned between the cavity wall tissue (or othertissue to remain) and the tonsil tissue (or other tissue to be removed).Once the desired position has been achieved, jaw members 410, 420 aremoved to the approximated position to grasp tissue between thetissue-treating plate portions 414 a, 414 b of jaw member 410 and thetissue-treating plate portions 424 a, 424 b of jaw member 420. Morespecifically, a first portion of tissue is grasped betweentissue-treating plate portions 414 a, 424 a and a second portion oftissue is grasped between tissue-treating plate portions 414 b, 424 b.

Thereafter, tissue-treating plate portions 414 a, 414 b may be energizedto a first electrical potential and tissue-treating plate portions 424a, 424 b to a second, different electrical potential for conductingenergy therebetween and through tissue grasped between jaw members 410,420 to treat tissue. More specifically, both the first portion of tissuegrasped between tissue-treating plate portions 414 a, 424 a and a secondportion of tissue grasped between tissue-treating plate portions 414 b,424 b are treated via the conduction of energy therethrough.

Once tissue has been treated, the tissue to be removed, e.g., the tonsiltissue, is separated from the tissue to remain, e.g., the wall tissue.In order to separate the tissue, jaw members 410, 420 are moved from theun-actuated position to the actuated position such that jaw components410 a, 420 a are moved apart from respective jaw components 410 b, 420b. Thus, as jaw members 410, 420 are moved from the un-actuated positionto the actuated position, the first and second portions ofpreviously-treated tissue are pulled apart from one another, ultimatelysuch that the tissue disposed therebetween is ripped and/or torn,separating the first and second portions of previously-treated tissuefrom one another. With respect to tonsillectomy procedures, for example,moving jaw members 410, 420 from the un-actuated position to theactuated position separates the tonsil tissue to be removed from thewall tissue to remain. The separated tonsil tissue (or other tissue) maythen be removed using end effector assembly 400, another graspinginstrument, a suction device, or via other suitable method.

The various embodiments disclosed herein may also be configured to workwith robotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe surgeon and allow remote operation (or partial remote operation) ofsurgical instrumentation. Various robotic arms, gears, cams, pulleys,electric and mechanical motors, etc. may be employed for this purposeand may be designed with a robotic surgical system to assist the surgeonduring the course of an operation or treatment. Such robotic systems mayinclude remotely steerable systems, automatically flexible surgicalsystems, remotely flexible surgical systems, remotely articulatingsurgical systems, wireless surgical systems, modular or selectivelyconfigurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prep the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent, smaller or larger, than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. While several embodiments of the disclosure have been shownin the drawings, it is not intended that the disclosure be limitedthereto, as it is intended that the disclosure be as broad in scope asthe art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

What is claimed is:
 1. A method of surgery, comprising: grasping tissuebetween tissue-treating plates of first and second jaw members by movingthe first and second jaw members from a spaced-apart position to a firstapproximated position; energizing the tissue-treating plates of thefirst and second jaw members for conducting energy through graspedtissue to treat grasped tissue; and separating grasped and treatedtissue by moving the first and second jaw members from the firstapproximated position to a second approximated position, wherein movingthe first and second jaw members from the first approximated position tothe second approximated position laterally shifts the jaw membersrelative to one another from an aligned orientation, wherein thetissue-treating plates are aligned with one another, to an offsetorientation, wherein the tissue-treating plates are laterally offset andparallel relative to one another.
 2. The method according to claim 1,wherein grasping tissue includes compressing a movable handle relativeto a fixed handle from an initial position to a first compressedposition to move the jaw members from the spaced-apart position to thefirst approximated position and wherein separating grasped and treatedtissue includes compressing the movable handle from the first compressedposition to a second compressed position to move the jaw members fromthe first approximated position to the second approximated position. 3.A method of surgery, comprising: grasping tissue between tissue-treatingsurfaces of first and second jaw members by moving at least one of thefirst or second jaw members relative to the other of the first or secondjaw members from an aligned, spaced-apart position to an aligned,approximated position; energizing the tissue-treating surfaces of thefirst and second jaw members to conduct energy through grasped tissue totreat grasped tissue; and separating grasped and treated tissue byfurther approximating and laterally shifting the at least one of thefirst or second jaw members relative to the other of the first or secondjaw members from the aligned, approximated position in which thetissue-treating surfaces are aligned with one another and define a firstgap distance therebetween to an offset, further approximated position inwhich the tissue-treating surfaces are laterally offset and parallelrelative to one another and define a second smaller gap distancetherebetween.
 4. The method according to claim 3, wherein graspingtissue includes compressing a movable handle relative to a fixed handlefrom an initial position to a first compressed position to move the jawmembers from the aligned, spaced-apart position to the aligned,approximated position.
 5. The method according to claim 4, whereinseparating grasped and treated tissue includes compressing the movablehandle from the first compressed position to a second compressedposition to move the jaw members from the aligned, approximated positionto the offset, further approximated position.